Xeplion

Uses

Schizophrenia: Xeplion Extended-Release Tablets are used for the treatment of schizophrenia

The efficacy of Xeplion in schizophrenia was established in three 6-week trials in adults and one 6-week trial in adolescents, as well as one maintenance trial in adults.

Schizoaffective Disorder: Xeplion Extended-Release Tablets are used for the treatment of schizoaffective disorder as monotherapy and an adjunct to mood stabilizers and/or antidepressant therapy

The efficacy of Xeplion in schizoaffective disorder was established in two 6-week trials in adults.

Xeplion is also used to associated treatment for these conditions: Delusional Parasitosis, Schizoaffective Disorders, Schizophrenia

How Xeplion works

Xeplion is the major active metabolite of risperidone. The mechanism of action of paliperidone, as with other drugs having efficacy in schizophrenia, is unknown, but it has been proposed that the drug's therapeutic activity in schizophrenia is mediated through a combination of central dopamine Type 2 (D2) and serotonin Type 2 (5HT2A) receptor antagonism.

Dosage

Xeplion dosage

Schizophrenia:

• Adults: The recommended dose of Xeplion Extended-Release Tablets for the treatment of schizophrenia in adults is 6 mg administered once daily. Initial dose titration is not required. Although it has not been systematically established that doses above 6 mg have additional benefit, there was a general trend for greater effects with higher doses. This must be weighed against the dose-related increase in adverse reactions. Thus, some patients may benefit from higher doses, up to 12 mg/day, and for some patients, a lower dose of 3 mg/day may be sufficient. Dose increases above 6 mg/day should be made only after clinical reassessment and generally should occur at intervals of more than 5 days. When dose increases are indicated, increments of 3 mg/day are recommended. The maximum recommended dose is 12 mg/day.
• Adolescents (12-17 Years Of Age): The recommended starting dose of Xeplion Extended-Release Tablets for the treatment of schizophrenia in adolescents 12-17 years of age is 3 mg administered once daily. Initial dose titration is not required. Dose increases, if considered necessary, should be made only after clinical reassessment and should occur at increments of 3 mg/day at intervals of more than 5 days. Prescribers should be mindful that, in the adolescent schizophrenia study, there was no clear enhancement to efficacy at the higher doses, i.e., 6 mg for subjects weighing less than 51 kg and 12 mg for subjects weighing 51 kg or greater, while adverse events were dose-related.

Schizoaffective Disorder: The recommended dose of Xeplion Extended-Release Tablets for the treatment of schizoaffective disorder in adults is 6 mg administered once daily. Initial dose titration is not required. Some patients may benefit from lower or higher doses within the recommended dose range of 3 to 12 mg once daily. A general trend for greater effects was seen with higher doses. This trend must be weighed against dose-related increase in adverse reactions. Dosage adjustment, if indicated, should occur only after clinical reassessment. Dose increases, if indicated, generally should occur at intervals of more than 4 days. When dose increases are indicated, increments of 3 mg/day are recommended. The maximum recommended dose is 12 mg/day.

Xeplion can be taken with or without food. Xeplion must be swallowed whole with the aid of liquids. Tablets should not be chewed, divided, or crushed. The medication is contained within a nonabsorbable shell designed to release the drug at a controlled rate. The tablet shell, along with insoluble core components, is eliminated from the body; patients should not be concerned if they occasionally notice in their stool something that looks like a tablet.

Side Effects

The following adverse reactions are observed:Increased mortality in elderly patients with dementia-related psychosis, Cerebrovascular adverse reactions, including stroke, in elderly patients with dementia-related psychosis, Neuroleptic malignant syndrome, QT prolongation, Tardive dyskinesia, Metabolic changes, Hyperprolactinemia, Potential for gastrointestinal obstruction, Orthostatic hypotension and syncope, Falls, Leukopenia, neutropenia, and agranulocytosis, Potential for cognitive and motor impairment, Seizures, Dysphagia, Suicide, Priapism, Thrombotic thrombocytopenic purpura (TTP), Disruption of body temperature regulation, Antiemetic effect, Increased sensitivity in patients with Parkinson's disease or those with dementia with Lewy bodies, Diseases or conditions that could affect metabolism or hemodynamic responses

Toxicity

The possibility of obtundation, seizures, or dystonic reaction of the head and neck following overdose may create a risk of aspiration with induced emesis.

Food Interaction

• Avoid alcohol.

[Moderate] GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of paliperidone.

Use in combination may result in additive central nervous system depression and

Administration with food may increase the bioavailability of paliperidone from the extended release tablets.

In healthy ambulatory subjects, administration of a 12 mg paliperidone extended release tablet with a standard high-fat

The clinical significance of these changes is unknown.

MANAGEMENT: Patients receiving paliperidone should be advised to avoid the consumption of alcohol.

Since clinical trials establishing the safety and efficacy of paliperidone were carried out without regard to the timing of meals, presumably paliperidone may be administered with or without food.

Xeplion Cholesterol interaction

[Moderate] Atypical antipsychotic drugs have been associated with undesirable alterations in lipid levels.

While all agents in the class have been shown to produce some changes, each drug has its own specific risk profile.

Before or soon after initiation of antipsychotic medication, obtain a fasting lipid profile at baseline and monitor periodically during treatment.

Xeplion Drug Interaction

Major: haloperidol, escitalopram, topiramateModerate: aripiprazole, lorazepam, diphenhydramine, duloxetine, lamotrigine, lurasidone, lithium, pregabalin, brexpiprazole, quetiapine, diazepam, cariprazineUnknown: amphetamine / dextroamphetamine, omega-3 polyunsaturated fatty acids, acetaminophen, cyanocobalamin, cholecalciferol

Xeplion Disease Interaction

Major: dementia, QT Prolongation, NMS, tardive dyskinesiaModerate: depression, aspiration, seizure, hematologic abnormalities, hyperglycemia/diabetes, hypotension, lipid alterations, priapism, weight gain, hyperprolactinemia, antiemetic effect, gastrointestinal obstruction

Volume of Distribution

• 487 L

Elimination Route

The absolute oral bioavailability of paliperidone following paliperidone administration is 28%.

Half Life

The terminal elimination half-life of paliperidone is approximately 23 hours.

Elimination Route

One week following administration of a single oral dose of 1 mg immediate-release 14C-paliperidone to 5 healthy volunteers, 59% (range 51% – 67%) of the dose was excreted unchanged into urine, 32% (26% – 41%) of the dose was recovered as metabolites, and 6% – 12% of the dose was not recovered.

Pregnancy & Breastfeeding use

Pregnancy Category C. There are no adequate and well controlled studies of Xeplion in pregnant women.

Use of first generation antipsychotic drugs during the last trimester of pregnancy has been associated with extrapyramidal symptoms in the neonate. These symptoms are usually self- limited. It is not known whether paliperidone, when taken near the end of pregnancy, will lead to similar neonatal signs and symptoms.

Nursing Mothers: Xeplion is excreted in human breast milk. The known benefits of breastfeeding should be weighed against the unknown risks of infant exposure to paliperidone.

Contraindication

Xeplion is contraindicated in patients with a known hypersensitivity to either paliperidone or risperidone, or to any of the excipients in the Xeplion formulation. Hypersensitivity reactions, including anaphylactic reactions and angioedema, have been reported in patients treated with risperidone and in patients treated with paliperidone. Xeplion is a metabolite of risperidone.

Interaction with other Medicine

Renal Impairment: Dosing must be individualized according to the patient's renal function status

Hepatic Impairment: No dosage adjustment is required in patients with mild to moderate hepatic impairment. Xeplion has not been studied in patients with severe hepatic impairment.

Elderly: No dosage adjustment is recommended based on age alone. However, dose adjustment may be required because of age-related decreases in creatinine clearance

Storage Condition

Store up to 25°C; excursions permitted to 15 -30°C. Protect from moisture. Keep out of reach of children.

Innovators Monograph

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